Antimicrobial therapy for Legionnaires’ disease?

Is there any data that supports that one quinolone is more effective than another? A physician in our hospital thinks that gatifloxacin is superior, yet I don’t see it recommended as a primary regimen in The Sanford Guide to Antimicrobial Therapy 2003 edition.

In the textbook Antimicrobial Therapy and Vaccines and the companion website,, we explicitly caution against the use of gatifloxacin for Legionnaires’ disease. To our knowledge, there is not a single culture-confirmed case ever cured with gatifloxacin. We believe it should not have been FDA-approved without that clinical experience.

The most potent quinolone in the intracellular model is levofloxacin. The largest clinical experience by far is with levofloxacin with an extraordinarily high rate of cure (Yu Chest 2004). Ciprofloxacin has also been successfully used. Moxifloxacin and gemifloxacin may be equally effective, but clinical data is minimal